1659396158 NPI number — MICHAEL JOHN KRAMER MD

Table of content: MICHAEL JOHN KRAMER MD (NPI 1659396158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659396158 NPI number — MICHAEL JOHN KRAMER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRAMER
Provider First Name:
MICHAEL
Provider Middle Name:
JOHN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659396158
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4535 DRESSLER RD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44718-2545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-493-4443
Provider Business Mailing Address Fax Number:
330-493-8677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 E LAKE MEAD PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89015-5575
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-616-4600
Provider Business Practice Location Address Fax Number:
702-616-4604
Provider Enumeration Date:
07/13/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  27024 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 036070496 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 2455A , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 5226 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CC3519 . This is a "BCBS NV" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 2002032 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: W20700 , issued by the state of ( WY ) . This identifiers is of the category "MEDICARE PIN".
  • Identifier: 1659396158 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34714 , issued by the state of ( NV ) . This identifiers is of the category "MEDICARE PIN".
  • Identifier: D44132 , issued by the state of ( NV ) . This identifiers is of the category "MEDICARE UPIN".
  • Identifier: 314437 . This is a "BSWY" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 605960009 . This is a "USDLAB" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".